Vital, EM orcid.org/0000-0003-1637-4755, Wittmann, M orcid.org/0000-0003-2328-4926, Edward, S et al. (5 more authors) (2015) Brief report: Responses to rituximab suggest B cell-independent inflammation in cutaneous systemic lupus erythematosus. Arthritis and Rheumatology, 67 (6). pp. 1586-1591. ISSN 2326-5191
Abstract
Objective The immunopathogenesis of systemic lupus erythematosus (SLE) is heterogeneous, and responses of skin to rituximab are variable. This study was undertaken to determine the phenotype of rituximab-responsive disease. Methods Eighty-two patients with SLE who were receiving rituximab were prospectively studied. Of these patients, 32 had significant skin involvement before or after treatment. Disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index 2004. Cutaneous lupus subtype was classified by a dermatologist as acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE), chronic cutaneous lupus erythematosus (CCLE), or other skin diseases, with supportive photographs or biopsies where necessary. Results Of 26 patients with skin disease at baseline, 9 (35%) had a beneficial mucocutaneous response to rituximab at 6 months, with good responses in ACLE (6 of 14 patients [43%]), and poor responses in CCLE (0 of 8 patients) (P=0.034). Clinical response was associated with anti-RNP negativity (P=0.024) and anti-Ro negativity (P=0.031). Flares of SCLE and CCLE occurred in 12 patients who either had no skin disease or had ACLE at baseline (i.e., a switch in subtype). Concomitant antimalarials or conventional immunosuppressants were not associated with response or flare rate. Posttreatment biopsies confirmed typical active SLE histology in lesions occurring during B cell depletion. Conclusion Our findings indicate that the clinical response to rituximab in cutaneous manifestations of SLE depends on subtype. None of the CCLE patients responded, and new CCLE lesions were observed during B cell depletion, suggesting that initiation and activity of these lesions is not B cell dependent. Flares of a range of skin diseases after B cell depletion may indicate a change in immune regulation following B cell-targeted therapy.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | (c) 2015, American College of Rheumatology. This is the peer reviewed version of the following article: Vital, E. M., Wittmann, M., Edward, S., Md Yusof, M. Y., MacIver, H., Pease, C. T., Goodfield, M. and Emery, P. (2015), Brief Report: Responses to Rituximab Suggest B Cell–Independent Inflammation in Cutaneous Systemic Lupus Erythematosus. Arthritis & Rheumatology, 67: 1586–1591. doi: 10.1002/art.39085, which has been published in final form at http://dx.doi.org/10.1002/art.39085. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. |
Keywords: | Autoimmune Diseases; B cell Targets; Biologic Response Modifiers; Systemic Lupus Erythematosus |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Clinical Musculoskeletal Medicine (LIRMM) (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Experimental Musculoskeletal Medicine (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Inflammatory Arthritis (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 26 Aug 2015 09:22 |
Last Modified: | 15 Mar 2019 13:23 |
Published Version: | http://dx.doi.org/10.1002/art.39085 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1002/art.39085 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:85078 |